Managing Disease Without Insurance
By Roni Caryn Rabin
New York Times
Prescriptions Blog
October 23, 2009
Americans without health insurance are less likely to know if they have diabetes or high cholesterol than those with coverage, and they’re less likely to keep their high blood pressure under control than the insured, a new study reports.
The researchers used national health survey data to look at three chronic but manageable health conditions — diabetes, hypertension and high cholesterol — that can lead to serious long-term complications when not kept in check. The long-term problems, including heart attacks, strokes and kidney disease, are expensive conditions that are often treated at public expense, contributing to overall health care costs.
Some 46 percent of uninsured people with diabetes had never been diagnosed with the disease, compared with only 23.2 percent of insured diabetics, the researchers found. Over half of the uninsured people with high cholesterol, or 52 percent, did not know about their condition, compared with 29.9 percent of the insured.
Whether insured or not, about three-quarters of those with high blood pressure had been given a diagnosis, which may reflect a broad public health effort to raise awareness about this common condition and the ease with which it can be checked at a health fair or drugstore. But without insurance, people were less likely to keep their blood pressure under control: 58 percent of uninsured hypertensives had uncontrolled blood pressure, compared with 51.2 percent of the insured.
Likewise, 77.5 percent of uninsured patients with elevated cholesterol were not keeping it under control, compared with 60.4 percent of the insured.
While the goal of the study was to learn how common it is for uninsured people to have a perfectly manageable condition that goes undiagnosed and therefore untreated, the researchers stumbled on a disturbing finding: even people with insurance weren’t doing very well keeping these conditions under control.
“It was striking,” said Andrew P. Wilper, lead author of the paper, which appeared in the journal Health Affairs. “The control of some of these chronic illnesses, even for the insured, is not that great. Among the uninsured, it is even worse.”
The insured and uninsured did not differ much in their control of diabetes, for example. Some 44.2 percent of insured diabetics had uncontrolled diabetes, compared with 46.6 percent of uninsured diabetics.
The study analyzed data about from the National Health and Nutrition Examination Survey of 1999-2006, which included interviews of 41,510 people. Other information was gleaned from questionnaires, physical exams and lab data, and individuals who were under 18 or older than 64 were excluded. About one in five people in the sample did not have health insurance.